AT

• Review Statistics of Veterans’ Illness and
Death in PA
• Describe the Differences between VA Model of Care and Community care
• Develop an Understanding of the “WE Honor
Veterans” Campaign
• Develop an Understanding of the “No Veteran
Dies alone” Mission

• Rank 5 th in the nation for Percent of Veteran
Population > 65 years

• Ranks 5 th in the nation for Veteran Deaths

Pennsylvania Statistics
Veterans Enrolled in VA
• Total Veterans = 1,014,884
– War Time = 708,200
– Gulf War = 183,500
– Vietnam = 320,400
– Korean Conflict = 117,700
– WWII = 109,800
– Peacetime = 255, 900
– OIF/OEF/OND = 51, 784
National Center for Veterans Analysis and Statistics, 2010
VISN 4 OIFOEF Dashboard, 2012

Only 4% of Veterans die in VA
(~21,000)
~642,370 Veterans will die in 2012
MANY with advanced serious illness
PTF file and VetPop for 2012

30
25
20
15
10
5
0
Has a service connected disability
Uses VA
Health care
Use VA only No Health
Coverage
Below poverty
Male
Female
Source: U.S. Census Bureau, American Community Survey PUMS, 2009
Prepared by the National Center for Veterans Analysis and Statistics

Culture
Role
Funding
Location
Accountability
Veteran Affairs (VA)
Quasi- Military
Provider and Payer
Fixed appropriation and budget
Congress
Large Medical Centers
CBOC’s
Community
Nurse-led Movement
Provider
Entitlement-
Medicare/Medicaid hospice benefit: 3 rd party reimbursement
Governing body, CMS,
Fiscal Intermediaries, and
State
Private Homes

Film clip

• Holistic
• Interdisciplinary Model
– Nursing
– Spiritual
– Psychosocial
– Symptom Management
– Medical Management

Palliative Care
• Even if a Veteran meets eligibility criteria for Hospice
Care, he might not be mentally ready for Hospice care.
• Palliative care (skilled nursing care symptom management) is offered until the Veterans symptoms are managed to an acceptable level set by the veteran.
Palliative Care continues until the skilled need or the goals of therapy are met or the veteran elects Hospice care.

• Palliative care falls under the homecare umbrella of insurance coverage and can be offered through a home health and hospice agency. Not all homecare/hospice agencies have palliative care teams available.
• The Veteran must have a skilled need and be homebound in order for insurance to pay for it.

Home Hospice Care is provided wherever the Veteran calls Home
The VA purchases Community Hospice Service as a Comprehensive
Bundled per Diem Service for a Specific Period of Time.
If a Veteran has Medicare or Other Private insurance, he may elect to have the VA pay or his other insurance pay.
If a Veteran does not have insurance to pay for hospice care, the VA will pay through FEE basis, for the care the Veteran needs, through a community hospice agency.

The VA will pay for 3 levels of community hospice care
• Routine home care
• Continuous care
• Inpatient Care when indicated
For inpatient care, the hospice agency is to contact the VA for authorization prior to admission to an contracted facility.

A VA Facility should be considered before a community facility
Reasons for Inpatient Admissions for Hospice and Palliative Care
• Uncontrolled Symptoms
• Inadequate Care or No Caregiver
• Caregiver Burden

• Cultural Impacts
• Fears
• Different War Eras
• Where They Served, How They Served

• Military Service
– Military Values
– Stoicism
• Combat influences
– Heroic Measures
– Advance Directives
– Pets

65% Veterans :
• Have Poor Support Systems
• Have Psychological Stress
• Prefer the “Strength of many and the power and wisdom of the group”
• Oppose Institutionalization at End-of Life
• Desires Open Communication with Professionals

• WWII
– Cold Injuries
– Mustard Gas Effects
– PTSD vs. Delirium
– Radiation Exposure
• Korean Conflict
– Cold sensitivity
– PTSD
– Minimizing of Experiences

• Vietnam
– Alcohol/Substance abuse
– Agent Orange Exposure
– Homelessness
– Increased need for care
• Gulf war/OEF/OIF
– Exposure to Toxins
– Gulf war Syndrome
– TBI
– Chronic Fatigue Syndrome

PTSD- Post Traumatic Stress Disorder
• What is PTSD?
• 3 Major Symptoms
– Re-experiencing
– Avoidance
– Increased Arousal
• Management
• Spiritual and Emotional Distress
• Interdisciplinary Approach to Care

• We Honor Veterans
• No Veteran Dies Alone

Designed to empower hospice professionals to meet the unique needs of dying Veterans :
• Military Check list
• Honoring Veteran Medical Needs
• PTSD & Psychosocial Needs
• Veteran Healthcare Benefits

How to Become Involved…
• Enroll
• Learn
• Complete Activity Reports
• Network

VA Provides Tiered Recognition
• Level 1- Commit to Program
• Level 2- Provide Education to Staff
Identify Veterans
• Level 3- Strengthen Relationships with VA
• Level 4- Increase Access and Quality Care to
•
Veterans

• “No one should die alone…. Each human
should die with the site of a loving face”
-Mother Teresa of Calcutta
• What is it?
• Who may help?
• How to help?

• National initiative
• The Department of Veterans Affairs says its mission is "to fulfill President Lincoln's promise ... 'To care for him who shall have borne the battle.' “
• VA hospitals around the country, provide the special care that Veterans desire when their final battle is coming to an end.

Jim Cooper
• Navy Frogman
• Korean War Veteran
• Advanced COPD

Home Care Agencies’ Best Friends
 Federal Guide to Veteran & Dependent Benefits (on line & in print)
 www.va.gov
(VA benefits, especially healthcare)
 www.vba.va.gov
(general VA benefits)
 VHA Handbook 1140.5 (Community Hospice Referral & Purchase
Procedures)
 Your local VA facility Hospice/ Palliative Care POC, Community
Home Health Coordinator and Pre-registration staff
 County Veteran Representatives – located usually in county courthouses

• Growing Numbers of Veterans
• Unique Needs
• How can WE honor Veterans?
– Collaboration
– Use of tools and Expertise
– Partnerships